I started to ask if there had been a problem with childbirth. What you describe in Robert's delivery is almost exactly what we went thru with Matt. Matt's wasn't as long but that is because of the problems leading up to the delivery. Mom spent the last week of the pregnancy in the hospital with complications. There was a previous attempt to induce labor a few days before Matt was born. The second time they attempted to induce labor the doc broke her water and said that one way or another there would be a baby. She went from 2 to 10 cm dialation in a couple hours. Then, she pushed for 4 hours before the doc discovered that Matt was turned wrong. Off to the delivery room for the forceps (salad spoons as Bill Cosby calls them), with the operating room on stand-by. Matt had a cone on the back right part of his head for months.
Interestingly, that cone would have compressed the brain into the skull (left front) directly where the cyst would be found some 21 years later.
Matt began having headaches toward the end of his 11th grade year of school. We thought he was just getting his dad's migraines. We chased it thru the normal medical channels until near the end of his first semester of his sophomore year in college. Finally he saw a doc who had seen the problem before and ordered a CT scan.
Based on the size of your son's cyst, it was getting to be nearly the same size as Matt's. Assuming that his cyst was caused by the problems in childbirth, he was probably due to start having the same headache problems as Matt did. You do understand that the brain has no pain receptors. The headache pain that Matt had (and probably Robert) was from the deformation of the skull bones and pressure on the sinuses and ear nerves.
These cysts are mainly caused when the channels that allow the circulation of the fluid in the cranium are stopped for whatever reasons. The fenestration reopens or creates an opening that allows the fluid to circulate again. It is possible for the new opening to close up. Some surgeons will put in a stint to keep the passage open. It depends on the preferences of the doctor and the patient.
When to have the surgery is based generally left up to the patient. If he can handle the pain and make it thru his finals, he may have enough time to recover during the summer and not miss a semester. Our mistake with Matt was in trying to have the surgery over the Christmas break and return to school in January. That was entirely too soon.
Matt does continue to have some problems with headaches. In his case he seems to be much more susceptible to headaches related to stress, poor diet, and/or poor rest habits. If I can make any after-care recommendations it would be related to that. Proper nutrition and keeping a strict sleep schedule seems to become even more important after the surgery. Stress related headaches seem to be much harsher as well.
Matt has never been a sportsman. His forte has always been music. He was a terrific talent on the clarinet. It got him over $4000 a year in scholarships. The pressure created by blowing, coupled with the concussion of the drums behind him was intollerable in the semester after his surgery. As a result, his scholarships weren't continued. Before he moved away, he had started getting back into playing but nothing like when he was in high school. I think that hurt his parents more than him but it still was hard on Matt as well.
Matt learned (and continues to learn) his own way about the limitations that having brain surgery puts on him. Matt learned quickly that any impact to the head is a real problem. He was knocked unconscious by a thrown pillow in the dormitory. Robert will likely have to learn many of those lessons his own way as well. The best any Dr or parent can do is to provide as much information as possible and hope that the lessons we taught them over the years will have stuck. Just make him understand that the hole in his skull changes how he has to protect himself.
A funny story here: A few days before his surgery, Matt called and said, "Hey dad, you remember all those things you told me I needed like I needed another hole in my head? Well, now that I'm getting that hole, can I have some of those things?"
It was a nice try, but we still told him no.
Again, I can't thank you enough for your reply - it all seems less daunting somehow, especially to know that Matt is doing so well. We are still waiting the specialists decision but Robert was reassured to think that he might be able to get this next lot of exams over and done with first. Hopefully we'll get a nice warm summer, (that doesn't happen very often over here), to recuperate. The complications during childbirth are uncannily similar. Robert was induced, the first attempt failing and so they too broke my waters. Robert was also turned the wrong way which forced the forceps delivery. It does make you wonder doesn't it? Anyway, I'll keep you posted with what happens, but your letters have helped far more than the hundreds of web sites I've visited during the last 48 hours. Many thanks, Sally.